Provider Demographics
NPI:1598581860
Name:ROUGHTON, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:ROUGHTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 RAY KREBBS AVE
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-4541
Mailing Address - Country:US
Mailing Address - Phone:816-591-8345
Mailing Address - Fax:
Practice Address - Street 1:416 MAIN ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-2512
Practice Address - Country:US
Practice Address - Phone:816-912-9601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS100-99302374700000X
MO2023027168374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374700000XNursing Service Related ProvidersTechnician